Effect of mycophenolate mofetil on the white blood cell count and the frequency of infection in systemic lupus erythematosus.

Leukopenia is a common manifestation of SLE. Addition of immunosuppressive therapy in a SLE patient who is already leukopenic is a clinical concern. It could worsen leukopenia, increase the risk of infection, or both. The aim of this study was to analyze the immediate effect of mycophenolate mofetil on the white blood cell count and the rate of infection in SLE patients. Two hundred and forty-four patients within the Hopkins Lupus Cohort who were newly started on mycophenolate mofetil were included in the study. The white blood cell count and interval infection history on the day mycophenolate mofetil was started were compared with the white blood cell count and interval infection history at the next visit. The study was based on 244 patients who began taking mycophenolate mofetil in the cohort. The study population included 47 % African Americans, 44 % Caucasians, and 9 % other ethnicities. There was a slight but not statistically significant increase in the white blood cell count (6.63 vs. 7.01), after starting mycophenolate mofetil. Patients with a baseline white blood cell count \u3c3000/mm(3) did have a statistically significant increase in the white blood cell count after starting mycophenolate mofetil (2.57 vs. 5.13, P = 0.0047). We also found a statistically significant increase in the risk of bacterial infection (but not viral infection) after starting mycophenolate mofetil (4 vs. 9 %, P = 0.0036). Leukopenia does not worsen with mycophenolate mofetil. However, mycophenolate mofetil appears to slightly increase the rate of bacterial (but not viral) infection

Strings with a confining core in a Quark-Gluon Plasma

We consider the intersection of N different interfaces interpolating between different $Z_N$ vacua of an SU(N) gauge theory using the Polyakov loop order parameter. Topological arguments show that at such a string-like junction, the order parameter should vanish, implying that the core of this string (i.e. the junction region of all the interfaces) is in the confining phase. Using the effective potential for the Polyakov loop proposed by Pisarski for QCD, we use numerical minimization technique and estimate the energy per unit length of the core of this string to be about 2.7 GeV/fm at a temperature about twice the critical temperature. For the parameters used, the interface tension is obtained to be about 7 GeV/fm$^2$. Lattice simulation of pure gauge theories should be able to investigate properties of these strings. For QCD with quarks, it has been discussed in the literature that this $Z_N$ symmetry may still be meaningful, with quark contributions leading to explicit breaking of this $Z_N$ symmetry. With this interpretation, such {\it QGP} strings may play important role in the evolution of the quark-gluon plasma phase and in the dynamics of quark-hadron transition.Comment: 18 pages, 6 figures, RevTe

Ayurvedic management of Pakshaghata in an Acute Stage - A Case Study

Stroke is a major non communicable disease. Hemiplagia is the commonest manifestation of a stroke with neurological deficit and symptoms having sudden weakness or numbness of the face, arm or leg most often on one side of the body. In India studies estimate that incidence of stroke varies from 116 to 163 per 100,000 population a/c to ICMR stroke is 4th leading cause of death and 5th leading cause of disability adjusted life year (DALY) . Materials and Methods: A 60 yr old female K/H/O Type 2 DM andHTN was diagnosed with a Avaranajanya Pakshaghata with a clinical feature complete loss of strength and function in left upper and lowerlimb has been treated with Agnilepa, Sarvanga Abhyanga followed by Shastika Shali Pinda Sweda and Dashamula Niruha Basti. Results: After the course of treatment the recovery was promising and worth documenting. Conclusion: CVA is broadly understood under the term Pakshaghata which can be menifest either due to Dhatukshaya or Avarana. In the present case treatment was done based on Avarana concept followed by Kevala Vatavyadhi Chikitsa. Thus the clinical approach to Pakshaghata varies accordingly with the Dosha and Avastha of Vyadhi

A conceptual study on mode of action of Abhyanga

Ayurveda literally means ‘science of life’. According to Ayurveda the term health does not stand only for the freedom from diseases but it is called as healthy only when a person’s mind, sense organs and the soul are in a perfect state of equilibrium to endow happiness and the body is free from diseases. So it is clear that maintaining a good health was for the longevity of life. Maharshi Charaka has used the term ‘Samhanana’ to denote the compactness of body.  A compact body is characterized by the symmetrical and well divided bones, well-knit joints and well bound muscles and blood. An individual having a compact body is very strong, otherwise he is weak. Thus a patient should be examined with reference to his Samhanana or compactness of the body. This is the main reason for why Ayurveda has given paramount importance on maintaining a positive health, either by following strict routine daily life and doing particular things or by getting some therapeutic measures, like Rasayana, Panchakarma etc. Abhyanga is the therapeutic intervention of Panchakarma in which the body is treated with simple or medicated oil on particular body part according to   need. Whenever there is a discomfort or uneasiness over the body we unknowingly try to soothe it through massage

Diagnosis and Management of Severe Peripartum Cardiomyopathy: Diagnosis dan Manajemen Kardiomiopati Peripartum Berat

Objective: To describe the diagnosis and management of severe peripartum cardiomyopathyMethods: A case report.Case: A 35-year-old woman presented with dyspnea and leg edema. The patient gave birth 3 months ago. The hemodynamic was unstable and the physical examination showed a mild rhonchi in the basal of the lung and pansystolic murmur in the apex. Echocardiography showed a dilated heart chamber and reduced ejection fraction (30%). The patient was diagnosed as severe PPCM. The initial management was to stabilize the patient using furosemide, catecholamine, and vasopressor administration. After the patient’s condition was stable, ramipril, bisoprolol, and bromocriptine were given as heart failure therapy.Conclusions: Patient with suspicion of PPCM should be managed thoroughly from detailed history taking to proper diagnostic testing such as echocardiography. Prompt treatment of severe PPCM according to the guideline will improve the cardiac function.Key words: catecholamines, echocardiography, peripartum cardiomyopathy, pregnancy, vasopressor.   Abstrak Tujuan: Untuk mendeskripsikan mengenai diagnosis dan manajemen pasien pada kasus kardiomiopati peripartum yang berat.Metode: Laporan kasus.Kasus: Seorang Perempuan 35 tahun datang dengan dispnea dan edema tungkai. Pasien melahirkan 3 bulan lalu. Hemodinamik tidak stabil dan pemeriksaan fisik menunjukkan ronki ringan di basal paru dan murmur pansistolik di apeks. Ekokardiografi menunjukkan dilatasi ruang jantung dan fraksi ejeksi berkurang (30%). Pasien didiagnosis dengan PPCM berat. Penatalaksanaan awal adalah menstabilkan pasien dengan pemberian furosemid, katekolamin, dan vasopresor. Setelah kondisi pasien stabil, diberikan ramipril, bisoprolol, dan bromokriptin sebagai terapi gagal jantung.Kesimpulan: Pasien dengan kecurigaan PPCM harus dikelola secara menyeluruh mulai dari anamnesa yang rinci hingga uji diagnostik yang tepat seperti ekokardiografi. Pengobatan segera untuk PPCM derajat berat yang sesuai dengan pedoman akan meningkatkan fungsi jantung.Kata kunci: ekokardiografi, kardiomiopati peripartum, katekolamin, kehamilan, vasopressor

To evaluate the effect of Panchaprasrutika Basti with and without Anuvasana in Janusandhigata Vata - A Comparative Clinical Study

Basti is considered as Ardha or Purna Chikitsa among the entire Panchakarma therapeutic measures. In Asthi Ashrita Vyadhi Panchakarma especially Basti Karma is Hitakari. Sandhigata Vata is one among the Vataja Nanatmaja Vyadhi mainly manifesting in Vridhdhavastha, which is dominated by Vata Dosha. Acharya Sushruta said it is difficult to cure and is Yapya. Charakacharya has explained that for the management of the diseases at Marmaasthi Sthanas, Vata Dosha is treated. Since Basti is considered the most effective for the management of Vata. Hence the present study “To evaluate the effect of Panchaprasrutka Basti with and without Anuvasana in Janusandhigata Vata - A Comparative Clinical Study, is undertaken here. Methodology: It is a comparative clinical study. 40 patients diagnosed as having Janusandhigata Vata fulfilling the inclusion criteria were selected from the OPD and IPD, SJIIM Hospital and GAMC Bengaluru and randomly assigned into following 2 groups each comprising of 20 patients. A special case proforma was prepared with all the points of History taking, physical examinations, laboratory investigations to confirm the diagnosis as mentioned in our classics and contemporary sciences. Group A: Patients of this group were given a course of Panchaprasrutika Basti with Anuvasana Basti. Group B: Patients of this group were given a course of Panchaprasrutika Basti without Anuvasana Basti. Patients of both groups were administered Basti in Yoga Basti pattern. After completion of study, results were assessed using student’s ‘t’ test by comparing the data collected during the study. Result: Both the groups were effective in Janusandhigata Vata. However clinically efficacy of Group A (65%) showed better results than Group B (60%)

Effective management of Hypothyroidism through Virechana - A Case Study

Thyroid gland is an endocrine gland in neck. It makes two hormones that are secreted into the blood. Thyroxine (T4), triiodothyronine (T3), These hormones are necessary for all the cells in body to work normally. Principal function of thyroid gland acts as catalyst for the maintenance of oxidative metabolism. Hypothyroidism is the most common endocrine disorder observed all over the world in present time. The normal and abnormal functions of thyroid gland can be co-related to healthy and altered status of Agni. So, hypothyroidism can be considered as a stage of Agnimandya, resulting in the formation of Ama leading to Bahudoshavastha. In the Bahudoshavastha condition of Ama, Doshavasechana is done. In this case study Virechana is performed by Trivrith Lehya after performing Deepana-Pachana and Shodhananga Snehapana with Guggulu Tiktaka Gritha. This study shows significant improvement in signs, symptoms of hypothyroidism and thyroid function test

Ayurvedic management of Enteropathic arthritis : A Case Study

Introduction: A Female patient aged 28 years with chief complaints of reduced appetite, increased frequency of defecation, vague body ache since 10 years approached our OPD. Patient was on eldoper for the past 10 years and recently developed multiple joint pain. This can be diagnosed as Enteropathic arthritis or Vataja grahani. Materials and Methods: A set of treatment principles were adopted including Piccha Basti and Amalaki Rasayana for 30 days. Results: Soon after DeepanaPachana, frequency of defecation reduced to 3-4times/day and further reduced to 1-2 times/day after Piccha Basti. After 30 days, urge for defecation soon after food intake subsided and there was considerable reduction in multiple joint pain. Discussion: There is no cure for this condition as such in modern system of medicine. By following the treatment principles mentioned in Ayurveda, proper Samprapti Vighatana of the disease along with prevention of recurrences can be achieved